Watch For These 5 Factors Before HRT

Hormone replacement therapy for women with metabolic syndrome raises cardiovascular risk

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Hormone replacement therapy is one of the most popular and effective treatments for the symptoms of menopause. But it has been plagued by conflicting information about its risks.

A recent study found a higher risk of heart problems during HRT can occur in women with a condition called metabolic syndrome.

"Ask your doctor about hormone therapy risks."

Metabolic syndrome occurs when people have three of the following five factors: blood pressure at or over 130/85 mmHg, fasting blood sugar level at or over 100 mg/dL, a waistline at or over 35 inches for women, an HDL ("good") cholesterol under 50 mg/dL for women or triglcerides at or over 150 mg/dL.

Having metabolic syndrome puts a person at higher risk for type 2 diabetes, coronary artery disease and stroke. It primarily occurs in people who are obese.

The study, led by Robert A. Wild, MD, MPH, PhD, of the Clinical Epidemiology and Obstetrics and Gynecology Departments at Oklahoma University Health Sciences Center, aimed to find out whether having metabolic syndrome made a difference in women's cardiovascular risk while taking hormone replacement therapy.

Their study used a smaller subset of the 27,347 women participating in the Women's Health Initiative, in which half received HRT and half received a placebo.

Using the 4-year follow-up data, the researchers identified 166 women who developed cardiovascular disease while taking HRT who did not start out with prior cardiovascular disease, diabetes or high blood pressure. Then they matched these women to 524 women who did not develop cardiovascular disease.

All the women were assessed for metabolic syndrome, and then the doctors calculated the link between metabolic syndrome and risk of cardiovascular disease.

They determined women who had metabolic syndrome were twice as likely to develop cardiovascular disease while taking HRT than women who did not have metabolic syndrome at the start of the trial.

This was true regardless of whether the women without metabolic syndrome did or did not take the hormone therapy.

One limitation of the study is that the women who were receiving HRT were taking the hormones orally. They were also age 66 on average, which is older than when most women start HRT.

Therefore, the newer methods of providing HRT and assessing the incidence among younger women might make a difference in the cardiovascular risks.

The study was published October 25 in the journal Menopause. The Women's Health Initiative program was funded by the National Heart, Lung and Blood Institute, the National Institutes of Health and the U.S. Department of Health and Human Services.

Two authors reported research support from Merck, Eli Lilly, Amylin, Novo Nordisk, Roche, Diasome and Sanofi.

Reviewed by: 
Review Date: 
November 4, 2012
Last Updated:
November 7, 2012